Pregnancy in a Pandemic: What We Learnt about Mental Health

When the COVID-19 pandemic hit, healthcare systems around the world had to adapt quickly. Maternity services in Australia were no exception. While the changes were necessary to reduce transmission, they brought unintended consequences, especially for the mental health of pregnant women.

As a midwife and researcher, I was concerned about how these disruptions were affecting the women in our care. Women were attending appointments alone, missing antenatal classes, and seeing fewer familiar faces throughout their pregnancy journey. It raised questions for us as a research team. How were women coping? What were the mental health impacts of these necessary but difficult changes?

To find out, we surveyed over 1600 Australian women in their third trimester between July 2020 and January 2021. We asked about anxiety, stress and depression, and the results were deeply concerning.

More than one in four women screened positive for depression. Around one in five reported moderate or higher levels of anxiety, and over 15 per cent were experiencing significant stress. These rates are far higher than what we typically see in non-pandemic settings.

Women who had a history of mental health issues, complex pregnancies or were under financial pressure were particularly at risk. On the other hand, social support from a partner or others was clearly protective. Interestingly, while continuity of carer is usually linked to better outcomes, our study did not find it had a significant impact when other factors were taken into account. This may reflect the timing of the survey, which was conducted before participants had completed their full episode of care.

Living in Victoria during its extended lockdown also had a strong effect. Women in that state were almost twice as likely to screen positive for depression compared to those in New South Wales. The cumulative toll of restrictions, isolation and uncertainty was evident in both the data and the stories women shared with us.

Our findings reinforce that pregnancy is a vulnerable time, emotionally as well as physically, and that this vulnerability was heightened by the pandemic. While public health measures were essential, we need to better protect the mental wellbeing of women during times of crisis. That means identifying at-risk groups early, maintaining social and emotional support where possible, and ensuring access to mental health care throughout pregnancy.

This research adds to a growing body of evidence about the impact of COVID-19 on maternal mental health. For midwives, doctors, policymakers and educators, it is a timely reminder that our maternity systems must not only adapt in times of crisis, they must also protect the emotional wellbeing of the women they serve.

Link to the full paper: https://www.sciencedirect.com/science/article/pii/S0266613823000220?via%3Dihub